A 51-year-old woman presents for evaluation of increasing right lower extremity swelling for the last 3 hours. She was hiking with her dog in the southwest US when she heard a rattling noise in a nearby bush. She bent over to examine where the sound was coming from when she felt a sharp pain in her right lower leg. She subsequently noticed a single puncture wound. Her exam is shown below, with pain radiating up to her inguinal region. Which of the following is recommended?
- 4-factor prothrombin complex concentrate
- Crotalidae polyvalent immune fragment-antigen binding antivenom
- Latrodectus antivenom
- Observation
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References:
- Gummin DD, Mowry JB, Spyker DA, Brooks DE, Fraser MO, Banner W. 2016 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 34th annual report. Clin Toxicol. 2017;55(10):1072–1252. https://www.tandfonline.com/doi/abs/10.1080/15563650.2017.1388087
- Norris RL, Bush SP, Cardwell MD. Bites by venomous reptiles in Canada, the United States, and Mexico. In: Auerbach PS, Cushing TA, Harris NS, eds. Auerbach’s Wilderness Medicine. 7th ed. Elsevier; 2017:(Ch) 35.
- Rokyta DR, Wray KP, Margres MJ. The genesis of an exceptionally lethal venom in the timber rattlesnake (Crotalus horridus) revealed through comparative venom-gland transcriptomics. BMC Genomics. 2013;14:394. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701607/
- Warrell DA. Bites by venomous and nonvenomous reptiles worldwide. In: Auerbach PS, Cushing TA, Harris NS, eds. Auerbach’s Wilderness Medicine. 7th ed. Elsevier; 2017:(Ch) 36.
Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie)
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